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General Thoracic Surgery Turnover Time Improvement Project
Daniel L. Miller, Barry Bryant, Avina Goel, Lorraine James, Maquitha Mitchell, Matt Klopman.
Emory University, Atlanta, GA, USA.

OBJECTIVE: In the majority of minimally invasive thoracic procedures, operative times are longer. Because of the longer operative times, turnover time between cases become an important issue in determining the number of cases that can be performed on a dally basis. Analysis at our institution found that our general thoracic surgery (GTS) turnover time (TOT) was greater than 60 minutes. Therefore, we set out to reduce the TOT to 30 minutes or less.
METHODS: We focused on the areas that we had control of - preop holding, operative room and recovery room. The factors that were identified as the areas of greatest need for improvement was preparation of cases carts, clarification of equipment needs, definition of room readiness, and definition of patient readiness. We then implemented the project and meet on a monthly basis to review the data and make improvements to the process as needed.
RESULTS: The project started in January 2012 in all GTS operating rooms, seven rooms a week and approximately 80 cases a month. TOT was calculated as from wheels out to wheels in. The data was divided into AM (0730-1159) and PM (>1200) and Overall. The first month's TOT was 43 min for AM, 56 min for PM, and 49 min Overall. By July 2013 we reached our Overall goal of 30 minutes (Graph). In our GTS operative rooms, an average of 3 to 4 cases are performed each day. By decreasing our TOT from 60 min to 30 min, we decreased the total TOT from 120-180 min to 60-90 min and the total operating room time per day.
CONCLUSIONS: Prolonged operative TOT can negatively affect patient care. By working as a team, our GTS service was able to reduce TOT by 50 percent. This reduction in TOT has lead to greater patient and employee satisfaction as well as decreased cost.

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